Surgical instrument with articulating shaft with single pivot closure and double pivot frame ground

ABSTRACT

A surgical stapling and severing instrument particularly suited to endoscopic use includes a proximal portion that is manipulated external to a patient to position an attached elongate shaft and end effector to a desired surgical site inside of the patient. An articulation joint pivotally attaches the end effector to the elongate shaft to give further clinical flexibility in reaching tissue at a desired angle. A closure tube assembly includes a single pivoting portion that overrides the articulation joint in order to distally translate to the end effector to close, yet pass over an articulated shaft by having a multiple pivot frame ground encompassed therein to accommodate the longitudinal change in closure sleeve pivot. Thereby, additional clinical flexibility in positioning the end effector is achieved without losing the ability for separate closure and firing motions transferred by the shaft.

CROSS REFERENCE TO RELATED APPLICATIONS

The present invention is a continuation-in-part of commonly owned U.S.patent application Ser. No. 11/061,908 now U.S. Pat. No. 7,559,450entitled “SURGICAL INSTRUMENT INCORPORATING A FLUID TRANSFER CONTROLLEDARTICULATION MECHANISM” to Kenneth Wales and Chad Boudreaux filed on 18Feb. 2005, the disclosure of which is hereby incorporated by referencein its entirety.

FIELD OF THE INVENTION

The present invention relates in general to surgical instruments thatare suitable for endoscopically inserting an end effector (e.g.,endocutter, grasper, cutter, staplers, clip applier, access device,drug/gene therapy delivery device, and an energy device usingultrasound, RF, laser, etc.) to a surgical site, and more particularlyto such surgical instruments with an articulating shaft.

BACKGROUND OF THE INVENTION

Endoscopic surgical instruments are often preferred over traditionalopen surgical devices since a smaller incision tends to reduce thepost-operative recovery time and complications. Consequently,significant development has gone into a range of endoscopic surgicalinstruments that are suitable for precise placement of a distal endeffector at a desired surgical site through a cannula of a trocar. Thesedistal end effectors engage the tissue in a number of ways to achieve adiagnostic or therapeutic effect (e.g., endocutter, grasper, cutter,staplers, clip applier, access device, drug/gene therapy deliverydevice, and energy device using ultrasound, RF, laser, etc.).

The positioning of the end effector is constrained by the trocar.Generally, these endoscopic surgical instruments include a long shaftbetween the end effector and a handle portion manipulated by theclinician. This long shaft enables insertion to a desired depth androtation about the longitudinal axis of the shaft, thereby positioningthe end effector to a degree. With judicious placement of the trocar anduse of graspers, for instance, through another trocar, often this amountof positioning is sufficient. Surgical stapling and severinginstruments, such as described in U.S. Pat. No. 5,465,895, are anexample of an endoscopic surgical instrument that successfully positionsan end effector by insertion and rotation.

More recently, U.S. patent Ser. No. 10/443,617, “SURGICAL STAPLINGINSTRUMENT INCORPORATING AN E-BEAM FIRING MECHANISM” to Shelton IV etal., filed on 20 May 2003, which is hereby incorporated by reference inits entirety, describes an improved “E-beam” firing bar for severingtissue and actuating staples. Some of the additional advantages includethe ability to affirmatively space the jaws of the end effector, or morespecifically a staple applying assembly, even if slightly too much ortoo little tissue is clamped for optimal staple formation. Moreover, theE-beam firing bar engages the end effector and staple cartridge in a waythat enables several beneficial lockouts to be incorporated.

These surgical stapling and severing instruments include a shaft havinga frame that guides a firing bar that performs the firing. A closuretube slides overtop of the frame and firing bar to effect closure of thejaws of the staple applying assembly. Thereby, a separate closure andfiring capability are provided that allow increased clinicalflexibility. The surgeon may repeatedly close and reposition tissueuntil satisfied with placement.

Depending upon the nature of the operation, it may be desirable tofurther adjust the positioning of the end effector of an endoscopicsurgical instrument. In particular, it is often desirable to orient theend effector at an axis transverse to the longitudinal axis of the shaftof the instrument. The transverse movement of the end effector relativeto the instrument shaft is conventionally referred to as “articulation”.This is typically accomplished by a pivot (or articulation) joint beingplaced in the extended shaft just proximal to the staple applyingassembly. This allows the surgeon to articulate the staple applyingassembly remotely to either side for better surgical placement of thestaple lines and easier tissue manipulation and orientation. Thisarticulated positioning permits the clinician to more easily engagetissue in some instances, such as behind an organ. In addition,articulated positioning advantageously allows an endoscope to bepositioned behind the end effector without being blocked by theinstrument shaft.

Approaches to articulating a surgical stapling and severing instrumenttend to be complicated by integrating control of the articulation alongwith the control of closing the end effector to clamp tissue and firethe end effector (i.e., stapling and severing) within the small diameterconstraints of an endoscopic instrument. Generally, the three controlmotions are all transferred through the shaft as longitudinaltranslations. For instance, in co-pending and commonly owned U.S. patentapplication Ser. No. 10/615,973 “SURGICAL INSTRUMENT INCORPORATING ANARTICULATION MECHANISM HAVING ROTATION ABOUT THE LONGITUDINAL AXIS” toFrederick E. Shelton IV et al, the disclosure of which is herebyincorporated by reference in its entirety, a rotational motion is usedto transfer articulation motion as an alternative to a longitudinalmotion.

Consequently, a significant need exists for a surgical stapling andsevering instrument having a shaft that includes a separate closure tubethat separately opens and closes the jaws, yet is capable ofarticulating.

BRIEF SUMMARY OF THE INVENTION

The invention overcomes the above-noted and other deficiencies of theprior art by providing a surgical instrument that includes a shafthaving a frame ground that pivotally attaches to an end effector via adouble pivoting connection. The end effector in turn includes a pivotalupper jaw or anvil that pivots to close and clamp tissue in response tolongitudinal movement of a closure tube that slides over the frame. Inorder to longitudinally translate to cause this closure over anarticulated joint, the frame ground has a double pivoting joint of itsown.

In one aspect of the invention, a surgical instrument includes aproximal portion that is manipulated external to a patient to positionan attached elongate shaft and end effector to a desired surgical siteinside of the patient. A closure tube includes a pivoting joint thatoverrides the articulation joint in order to distally translate to closethe end effector, yet pass over an articulated shaft. An articulationjoint pivotally attaches the end effector to the elongate shaft to givefurther clinical flexibility in reaching tissue at a desired angle. Toaccommodate the longitudinally moving pivot point of the closure tube, adouble pivoting frame ground has a link that is pivotally attached atits proximal and distal ends respectively to a proximal frame portionthat is attached to the handle portion and a distal frame portion thatis attached to the end effector. Thereby, additional clinicalflexibility in positioning the end effector is achieved without losingthe ability for separate closure and firing motions transferred by theshaft.

In another aspect of the invention, a surgical instrument includes anarticulating end effector that performs severing and stapling of clampedtissue between a closed anvil and elongate channel or lower jarcontaining a staple cartridge. A double pivoting frame ground includes alink that assists in articulating a firing bar that reciprocates withinthe elongate shaft of the surgical instrument.

These and other objects and advantages of the present invention shall bemade apparent from the accompanying drawings and the descriptionthereof.

BRIEF DESCRIPTION OF THE FIGURES

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate embodiments of the invention,and, together with the general description of the invention given aboveand the detailed description of the embodiments given below, serve toexplain the principles of the present invention.

FIG. 1 is a front top perspective view of a surgical stapling andsevering instrument shown with an open end effector, or staple applyingassembly, and with the staple cartridge removed.

FIG. 2 is a front top perspective view of the surgical stapling andsevering instrument of FIG. 1 with an articulation mechanism actuated bya fluidic actuation control.

FIG. 3 is a perspective disassembled view of an elongate shaft andarticulation mechanism of the surgical stapling and severing instrumentof FIG. 1.

FIG. 4 is a perspective disassembled view of distal portions of animplement portion of the surgical stapling and severing instrument ofFIG. 1, including the staple applying assembly and articulationmechanism.

FIG. 5 is a top perspective view of the staple applying assembly ofFIGS. 1 and 4 with a lateral half of a staple cartridge removed toexpose components driven by a firing motion.

FIG. 6 is a front perspective view of an implement portion of thesurgical instrument of FIG. 1 with a double pivot closure sleeveassembly and end effector removed to expose a single pivot frame groundarticulated by a fluidic articulation mechanism.

FIG. 7 is perspective detail view of an alternative articulation jointfor the surgical instrument of FIG. 1 depicting a double pivotingclosure sleeve assembly at a proximal position with a single pivot frameground.

FIG. 8 is a bottom right perspective exploded view of the alternativearticulation joint of FIG. 7 including a double pivoting fixed-wall dogbone link and a frame ground incorporating rail guides for a lateralmoving member (T-bar).

FIG. 9 is top left perspective exploded view of a further alternativearticulation joint for the surgical instrument of FIG. 1, including analternate solid wall support plate mechanism incorporated into a lowerdouble pivot link to support a firing bar and including a rail guidedlaterally moving member (T-bar).

FIG. 10 is a top diagrammatic view of an alternate articulation lockingmechanism for the surgical instrument of FIG. 1 with a closure sleeveassembly removed to expose a backloading disengaged T-bar for automaticarticulation lock engagement and disengagement.

FIG. 11 is a top diagrammatic view of an additional alternativearticulation mechanism for the surgical instrument of FIG. 1, a springbiased rack on a T-bar with locking features that engage due tobackloading from an end effector.

FIG. 12 is an alternative T-bar and frame ground incorporating lateralguidance for the surgical instrument of FIG. 1.

FIG. 13 is yet an additional alternative T-bar and frame groundincorporating lateral guidance for the surgical instrument of FIG. 1.

FIG. 14 is a left top perspective disassembled view of an alternativearticulation mechanism including a double pivoting frame assembly andsingle pivoting closure sleeve assembly for the surgical instrument ofFIG. 1. FIG. 15 is a left bottom perspective view of the alternativearticulation mechanism of FIG. 14.

FIG. 16 is a front perspective view of an alternative implement portionhaving a multiple pivot closure sleeve assembly for the surgicalstapling and severing instrument of FIG. 1.

DETAILED DESCRIPTION OF THE INVENTION

Overview Of Articulating Shaft.

Turning to the Drawings, wherein like numerals denote like componentsthroughout the several views, FIG. 1 depicts a surgical instrument,which in the illustrative versions is more particularly a surgicalstapling and severing instrument 10, that is capable of practicing theunique benefits of the present invention. In particular, the surgicalstapling and severing instrument 10 is sized for insertion, in anonarticulated state as depicted in FIG. 1, through a trocar cannulapassageway to a surgical site in a patient (not shown) for performing asurgical procedure. Once an implement portion 12 is inserted through acannula passageway, an articulation mechanism 14 incorporated into adistal portion of an elongate shaft 16 of the implement portion 12 maybe remotely articulated, as depicted in FIG. 2, by an articulationcontrol 18. An end effector, depicted in the illustrative version as astaple applying assembly 20, is distally attached to the articulationmechanism 14. Thus, remotely articulating the articulation mechanism 14thereby articulates the staple applying assembly 20 from a longitudinalaxis of the elongate shaft 16. Such an angled position may haveadvantages in approaching tissue from a desired angle for severing andstapling, approaching tissue otherwise obstructed by other organs andtissue, and/or allowing an endoscope to be positioned behind and alignedwith the staple applying assembly 20 for confirming placement.

Handle.

The surgical and stapling and severing instrument 10 includes a handleportion 22 proximally connected to the implement portion 12 forproviding positioning, articulation, closure and firing motions thereto.The handle portion 22 includes a pistol grip 24 toward which a closuretrigger 26 is pivotally and proximally drawn by the clinician to causeclamping, or closing, of the staple applying assembly 20. A firingtrigger 28 is farther outboard of the closure trigger 26 and ispivotally drawn by the clinician to cause the stapling and severing ofclamped tissue clamped in the staple applying assembly 20. Thereafter, aclosure release button 30 is depressed to release the clamped closuretrigger 26, and thus the severed and stapled ends of the clamped tissue.The handle portion 22 also includes a rotation knob 32 coupled formovement with the elongate shaft 16 to rotate the shaft 16 and thearticulated staple applying assembly 20 about the longitudinal axis ofthe shaft 16. The handle portion 22 also includes a firing retractionhandle 34 to assist in retracting a firing mechanism (not depicted inFIGS. 1-2) should binding occur, so that opening of the staple applyingassembly 20 may occur thereafter.

It will be appreciated that the terms “proximal” and “distal” are usedherein with reference to a clinician gripping a handle of an instrument.Thus, the surgical stapling assembly 20 is distal with respect to themore proximal handle portion 22. It will be further appreciated that,for convenience and clarity, spatial terms such as “vertical” and“horizontal” are used herein with respect to the drawings. However,surgical instruments are used in many orientations and positions, andthese terms are not intended to be limiting and absolute.

An illustrative multi-stroke handle portion 22 for the surgical staplingand severing instrument 10 of FIGS. 1-2 is described in greater detailin the co-pending and commonly-owned U.S. patent application entitled“SURGICAL STAPLING INSTRUMENT INCORPORATING A MULTISTROKE FIRINGPOSITION INDICATOR AND RETRACTION MECHANISM” to Swayze and Shelton IV,Ser. No. 10/674,026, the disclosure of which is hereby incorporated byreference in its entirety, with additional features and variations asdescribed herein. While a multi-stroke handle portion 22 advantageouslysupports applications with high firing forces over a long distance,applications consistent with the present invention may incorporate asingle firing stroke, such as described in co-pending and commonly ownedU.S. patent application “SURGICAL STAPLING INSTRUMENT HAVING SEPARATEDISTINCT CLOSING AND FIRING SYSTEMS” to Frederick E. Shelton IV, MichaelE. Setser, and Brian J. Hemmelgarn, Ser. No. 10/441,632, the disclosureof which is hereby incorporated by reference in its entirety. ImplementPortion (Articulating Elongate Shaft And Staple Applying Assembly).

In FIGS. 3-5, the implement portion 12 advantageously incorporates themultiple actuation motions of longitudinal rotation, articulation,closure and firing within a small diameter suitable for endoscopic andlaparoscopic procedures. The staple applying assembly 20 (“endeffector”) has a pair of pivotally opposed jaws, depicted as an elongatechannel 40 with a pivotally attached anvil 42 (FIGS. 1-2, 4-5). Closureand clamping of the anvil 42 to the elongate channel 40 is achieved bylongitudinally supporting the elongate channel 40 with a frame assembly44 (FIG. 3) rotatingly attached to the handle portion 22 over which adouble pivot closure sleeve assembly 46 longitudinally moves to impart aclosing and opening motion respectively to a distal and proximal motionto the anvil 42, even with the staple applying assembly 20 articulatedas in FIG. 2.

With particular reference to FIG. 3, the frame assembly 44 includes asingle pivot frame ground 48 whose proximal end is engaged to therotation knob 32, with a right half shell 50 thereon shown in FIG. 3. Itshould be appreciated that a proximal end of the closure sleeve assembly46, specifically of a closure straight tube 52, encompasses the proximalend of the frame ground 48, passing further internally to the handleportion 22 to engage closure components (not shown) that longitudinallytranslate the closure sleeve assembly 46. A circular lip 54 at theproximal end of the closure straight tube 52 provides a rotatingengagement to such components. Engaging components of the rotation knob32 pass through a longitudinal slot 56 on a proximal portion of thestraight closure tube 52 to engage an aperture 58 proximally positionedon the frame ground 48. The longitudinal slot 56 is of sufficient lengthto allow the closure longitudinal translation of the closure sleeveassembly 46 at various rotational angles set by the rotation knob 32 tothe closure sleeve assembly 46 and the frame ground 48.

The elongate shaft 16 supports the firing motion by receiving a firingrod 60 that rotatingly engages firing components of the handle portion22 (not shown). The firing rod 60 enters a proximal opening 62 along thelongitudinal centerline of the frame ground 48. The distal portion ofthe frame ground 48 includes a firing bar slot 64 along its bottom thatcommunicates with the proximal opening 62. A firing bar 66longitudinally translates in the firing bar slot 64 and includes anupwardly projecting proximal pin 68 that engages a distal end 70 of thefiring rod 60.

The elongate shaft 16 supports articulation by incorporating arectangular reservoir cavity 72, one lateral portion depicted in adistal portion of the rotation knob 32. A bottom compartment 74 thatresides within the rectangular reservoir cavity 72 has laterally spacedapart left and right baffles 76, 78. An articulation actuator 80 slideslaterally overtop of the bottom compartment 74, its downward laterallyspaced left and right flanges 82, 84, which are outboard of the baffles76, 78, each communicating laterally to left and right push buttons 86,88 that extend outwardly from the respective shell halves of therotation knob 32. The lateral movement of the articulation actuator 80draws left and right flanges 82, 84 nearer and farther respectively tothe left and right baffles 76, 78, operating against left and rightreservoir bladders 90, 92 of a fluidic articulation system 94, eachbladder 90, 92 communicating respectively and distally to left and rightfluid conduits or passageways 96, 98 that in turn communicaterespectively with left and right actuating bladders 100, 102. The latteroppose and laterally pivot a T-bar 104 of the articulation mechanism 14.

The frame assembly 44 constrains these fluidic actuations by including atop and distal recessed table 106 of the frame ground 48 upon whichresides the fluid passages 96, 98 and actuating bladders 100, 102. TheT-bar 104 also slidingly resides upon the recessed table 106 between theactuating bladders 100, 102. Proximal to the T-Bar 104, a raised barrierrib 108 is aligned thereto, serving to prevent inward expansion of thefluid passages 96, 98. The frame assembly 44 has a rounded top framecover (spacer) 110 that slides overtop of the frame ground 48,preventing vertical expansion of the fluid passages 96, 98 and actuatingbladders 100, 102, as well as constraining any vertical movement of theT-bar 104. In particular, the frame cover 110 includes features thatenable it to also provide an articulation locking member 111, describedin greater detail below as part of an articulation locking mechanism113.

A distal end (“rack”) 112 of the T-bar 104 engages to pivot a proximallydirected gear segment 115 of an articulated distal frame member 114 ofthe articulation mechanism 14. An articulated closure tube 116encompasses the articulated frame member 14 and includes a horseshoeaperture 118 that engages the anvil 42. A double pivoting attachment isformed between the closure straight tube 52 and articulating closurering 116 over the articulating mechanism 14, allowing longitudinalclosure motion even when the articulating mechanism 14 is articulated.In particular, top and bottom distally projecting pivot tabs 118, 120 onthe closure straight tube 52 having pin holes 122, 124 respectively arelongitudinally spaced away from corresponding top and bottom proximallyprojecting pivot tabs 126, 128 on the articulating closure ring 116having pin holes 130, 132 respectively. An upper double pivot link 134has longitudinally spaced upwardly directed distal and aft pins 136, 138that engage pin holes 122, 130 respectively and a lower double pivotlink 140 has longitudinally spaced downwardly projecting distal and aftpins 142, 144 that engage pin holes 124, 132 respectively.

With particular reference to FIG. 4, the articulating closure ring 116is shown for enhanced manufacturability to include a short tube 146attached to an articulating attachment collar 148 that includes theproximally projecting pivot tabs 126, 128. Similarly, the straightclosure tube 52 is assembled from a long closure tube 150 that attachesto an aft attachment collar 152 that includes the distally projectingpivot tabs 118, 120. The horseshoe aperture 118 in the short closuretube 146 engages an upwardly projecting anvil feature 154 slightlyproximal to lateral pivot pins 156 that engage pivot recesses 158 insideof the elongate channel 40.

The illustrative version of FIG. 4 includes a dog bone link 160 whoseproximal pin 157 pivotally attaches to the frame ground 48 in a framehole 161 and whose proximal pin 159 rigidly attaches to a proximalundersurface 162 of the articulating frame member 114, thereby providingpivotal support therebetween. A bottom longitudinal knife slot 163 inthe dog bone link 160 guides an articulating portion of the firing bar66. The articulating frame member 114 also includes a bottomlongitudinal slot 164 for guiding a distal portion of the firing bar 66.

Staple Applying Apparatus (End Effector).

With reference to FIGS. 4-5, the firing bar 66 distally terminates in anE-beam 165 that includes upper guide pins 166 that enter an anvil slot168 in the anvil 42 to verify and assist in maintaining the anvil 42 ina closed state during staple formation and severing. Spacing between theelongate channel 40 and anvil 42 is further maintained by the E-beam 164by having middle pins 170 slide along the top surface of the elongatechannel 40 while a bottom foot 172 opposingly slides along theundersurface of the elongate channel 40, guided by a longitudinalopening 174 in the elongate channel 40. A distally presented cuttingsurface 176 of the E-beam 164, which is between the upper guide pins 166and middle pin 170, severs clamped tissue while the E-beam actuates areplaceable staple cartridge 178 by distally moving a wedge sled 180that causes staple drivers 182 to cam upwardly driving staples 184 outof upwardly open staple holes 186 in a staple cartridge body 188,forming against a staple forming undersurface 190 of the anvil 42. Astaple cartridge tray 192 encompasses from the bottom the othercomponents of the staple cartridge 178 to hold them in place. The staplecartridge tray 192 includes a rearwardly open slot 194 that overlies thelongitudinal opening 174 in the elongate channel 40, thus the middlepins 170 pass inside of the staple cartridge tray 192.

The staple applying assembly 20 is described in greater detail inco-pending and commonly-owned U.S. patent application Ser. No.10/955,042, “ARTICULATING SURGICAL STAPLING INSTRUMENT INCORPORATING ATWO-PIECE E-BEAM FIRING MECHANISM” to Frederick E. Shelton IV, et al.,filed 30 Sep. 2004, the disclosure of which is hereby incorporated byreference in its entirety.

Articulation Locking Mechanism.

In FIGS. 3-4 and 6-8, an articulation locking mechanism 200 isadvantageously incorporated to maintain the staple applying assembly 20at a desired articulation angle. The articulation locking mechanism 200reduces loads on the left and right actuating bladders 100, 102. Inparticular, a compression spring 202 (FIG. 3) is proximally positionedbetween a proximal end 204 of the articulation locking member 111 andthe handle portion 22, biasing the articulation locking member 111distally. With particular reference to FIG. 4, two parallel slots 206,208 at a distal end 210 of the articulation locking member 111 receiverespectively upwardly projecting guide ribs 212, 214 on the frame ground48. The guide ribs 212, 214 are longitudinally shorter than the parallelslots 206, 208, allowing a range of relative longitudinal travel.Thereby, with particular reference to FIG. 8, selective abuttingengagement of a distal frictional surface, depicted as a toothed recess216 distally projecting from the articulation locking member 111, isengaged to a corresponding locking gear segment 217 in a brake plate 218received into a top proximal recess 220 of the articulating frame member114. Distal and proximal holes 221, 222 in the brake plate 218 receivedistal and proximal pins 223, 224 that upwardly project from the topproximal recess 220.

With particular reference to FIG. 6, the elongate shaft 16 is depictedin an articulated position with the closure sleeve assembly 46 removedfrom around the frame assembly 44 and without the elongate channel 40and anvil 42. Articulation actuator 80 is shown moved laterally to theleft to compress right proximal reservoir bladder 90 and expand distalright actuation bladder 100 moving T-bar 104 to the position shown.Thus, lateral movement of the articulation actuator 80 articulates thedistal frame 114 clockwise about the single pivot frame ground 48 asshown. The articulation actuator 80 advantageously also automaticallyengages and disengages the articulation locking mechanism 200. Inparticular, a toothed detent surface 225 along a proximal top surface ofthe articulation actuator 80 receives an upwardly projecting locking pin226 from the proximal end 204 of the articulation locking member 111.The engagement of the locking pin 226 within the root of the tootheddetent surface 225 provides sufficient distal movement of thearticulation locking member 111 for locking engagement of the lockinggear segment 217 in the brake plate 218. Lateral movement by an operatorof the compression member 272 proximally urges the locking pin 226proximally, and thus disengages the articulation locking member 111 fromthe brake plate 218. When the operator releases the articulationactuator 80, the locking pin 226 is urged by the compression spring 202into the adjacent detent in detent surface 225 to lock the lockingmechanism 111, and thereby the staple applying assembly 20, andconstrains the articulation mechanism 14 at a desired articulationposition by constraining and expanding the inflated shape of theproximal left and right reservoir bladders 90, 92.

Portions of the articulation lock mechanism 200 are described in greaterdetail in commonly-owned U.S. Pat. No. 5,673,841 “SURGICAL INSTRUMENT”to Dale R. Schulze and Kenneth S. Wales, et al., filed 10 Mar. 1996, thedisclosure of which is hereby incorporated by reference in its entirety.

Alternatively or additionally, an orifice may be provided withinparallel fluid bladders 236, 238 to control the flow rate between theproximal actuating bladders 100,102 and distal reservoir bladders 90,92. In FIGS. 16, 18, the fluid passageways 258, 264 may be sized toprovide resistance to changing the angle of articulation, serving as theorifices or as a fluid flow rate limiting structure.

In FIG. 10, an alternate locking mechanism 2000 of an articulationmechanism 2002 of a surgical instrument 2004 is normally unlocked and isactivated by cocking a laterally moving T-bar 2006 due to back loading.A slot 2008 is located in a frame ground 2010 to receive and guide a rib2012 extending down from the T-bar 2006. A slender longitudinal section2014, which is orthogonally attached to the rib 2012 deflects if an endeffector 2016 is backloaded. For instance, as the end effector 2016 isforced to the right as depicted at arrow 2018, for instance, itsproximal gear segment 2020 acts upon a rack 2022 of the T-bar 2006,imparting a nonorthogonal backdriving force, as depicted at arrow 2024.Thus, the slender longitudinal section 2014 bends, cocking rib 2012 inslot 2008. This cocking produces opposing binding forces, as depicted byarrows 2026, 2028, that lock the T-bar 2006 and prevent furtherarticulation. Unlocking occurs when actuation of the articulationbladders uncocks the laterally moving T-bar 2006. Thereafter, the rib2016 may assist in guiding the T-bar 2006.

In FIG. 11, yet an additional articulation locking mechanism 2100 for asurgical instrument 2102 is depicted that is normally unlocked andactivated by the proximal force vector from the 20 degree pressure anglefrom gear teeth 2104 of an end effector 2106 and rack teeth 2108 of aT-bar 2110. When the end effector 2106 is backloaded, as depicted bynonorthogonal arrow 2112, the longitudinal vector of the pressure angle,depicted as arrow 2114, moves the T-bar 2110 proximally. Thislongitudinal force vector is applied to a stiff spring 2118 behind arack 2120 of the T-bar 2110. When the spring 2118 deflects as T-bar 2110moves proximally, locking teeth 2126 projecting proximally from the rack2120 are brought into engagement with locking elements 2122 which areproximally and laterally aligned on a ground frame 2124 and brought intoengagement with locking teeth 2126 projecting proximally from the rack2120. The locking teeth 2126 and locking elements 2122 disengage whenthe proximal force vector is reduced or eliminated by removing the backloading of the end effector 2106, allowing T-bar 2110 to move distallyunder urging from spring 2118.

Double Pivot Closure Sleeve and Single Pivot Frame Ground Combination.

With reference to FIGS. 3-4 and 7, the implement portion 12advantageously incorporates the double pivot closure sleeve assembly 46that longitudinally translates over and encompasses a single pivot frameground 48. These mechanisms and their operation will now be described infurther detail. With particular reference to FIG. 7, the articulationmechanism 14 is depicted in an articulated state with the closure sleeveassembly 46 retracted proximally to an anvil open state. With the anvil42 open, actuation of the articulation control 18 causes the articulatedclosure ring 116 to pivot about the upwardly directed distal pin 136 anddownwardly directed distal pin 142 respectively of the upper and lowerdouble pivot closure links 134, 140. The frame ground 48 pivots around asingle pin, depicted as the proximal pin 1808 that joins frame ground 48to distal frame member 114. With the anvil 42 open, the proximal pin 147of frame ground 48 is aligned with the distal most position of upper andlower double pivot links 134, 140 of the closure sleeve assembly 46.This positioning allows easy pivoting and rotation of the stapleapplying assembly 20 while the anvil 42 is open. When the closure sleeveassembly 46 is moved distally to pivot anvil 42 closed, the closurestraight tube 52 moves distally about frame ground 48 and thearticulated closure ring 116 moves distally along the articulated distalframe member 114 axis as urged by pivot links 134, 140. Dual pivotingpins 136, 138 and 142, 144 on links 134, 140 facilitate engagement withclosure straight tube 52 and articulated closure ring 116 as they areurged towards the distal closure position when the device is articulated(not shown). At the distal closure position, the frame ground pivot pin(“proximal pin”) 147 is vertically aligned with proximal pivot pins 138,144 at full articulation or may fall at any point between distal pins136, 142 and proximal pins 138, 144 while working effectively.

Solid Firing Bar Support.

In FIG. 8, the articulation mechanism 14 of FIG. 7 is partially explodedand viewed from the bottom, showing a solid wall firing bar supportdesign (dog bone link 160) that offers advantages over conventionalflexible support plates. Support plates are used to bridge the gap andguide and support the firing bar 66 through a single frame ground pivotarticulation joint 1801. Flexible firing bars are known, but theincorporation of solid wall firing bars such as those shown in FIGS. 4,8 and 9 offer unique advantages. Referring now to FIG. 8, frame ground48 includes a frame knife slot 1802 that runs along the bottom of frameground 48 and a distal knife slot 164 runs along the bottom of anarticulating distal frame member 114 for the sliding reception of thefiring bar 66 (not shown) therein. Frame ground 48 described aboveincludes a direct single pivotal connection 1808 with the distal framemember 114. The fixed wall dog bone link 160 that is rotatably connectedon proximal pin end 157 and movably connected on distal pin end 159includes left and right lateral guides 1818, 1820, defining therebetweena guidance slot 1822 for sliding passage of a firing bar 66 (FIG. 4).

Thus, to bridge the gap between frame ground 48 and the distal framemember 114, the fixed wall pivoting dog bone link 160 is pivotallyattached to frame ground 48 and slidingly attached to frame member 114.Proximal pin 157 of the pivoting dog bone 160 is pivotally received in abore 1824 in frame ground 48 enabling pivotal dog bone 160 to pivotabout bore 1824. The distal pin 159 extends upwards from pivotal dogbone 160 and is slidingly received in a slot 1826 in distal frame 114.Articulation of staple applying assembly 20 to an angle of such as 45degrees from the longitudinal axis pivots pivoting dog bone 160 in bore1824 at its proximal pin 157, and distal pin 159 slides in slot 1826 tobend firing bar 66 to two spaced apart angles that are half of the angleof the staple applying assembly 20. Unlike previously referencedflexible support plates that bend the firing bar 66 to a 45 degreeangle, the fixed wall pivoting dog bone 160 bends the firing bar 66 totwo spaced apart angles of such as 22.5 degrees each. Bending theflexible firing bar or bars 66 to half the angle cuts the bend stress inthe firing bars 66 to one half of that found in conventionalarticulation supports. Reducing the bending stress in the firing bars 66reduces the possibility of permanently bending or placing a set in thefiring bars, reduces the possibilities of firing jams, ensures lowerfiring bar retraction forces, and provides smoother operation of thefiring system.

In FIG. 9, a surgical instrument 1900 includes a double closurepivot/single frame pivot articulation joint 1902 wherein an alternatesolid wall support plate mechanism 1904 replaces the lower double pivotlink 140 and dog bone link 1812. Left and right firing bar supports1906, 1908 extend upwardly from a lower double pivot link 1910 of aclosure sleeve assembly 1912. Clearance 1914 is provided in a frameground 1916 for the firing bar supports 1906, 1908 to travel as theclosure sleeve assembly 1912 moves distally to close the anvil 42 (notshown in FIG. 9) and proximally to open anvil 42. Like the abovedescribed pivoting dog bone 1812, the alternate lower double pivotinglink 1910 also bends and supports the firing bar 66 (not shown in FIG.9) to have two spaced apart bend angles that are up to one half of thebend angle of the staple applying assembly 20.

Lateral Member Guide Mechanisms.

With further reference to FIG. 9, left and right upward flanges 1918,1920 on the frame ground 1916 include distal and proximal lateral pinguides 1922, 1924 that pass laterally through holes in a T-bar 1926,assisting in minimizing binding in an articulation mechanism 1928. Asanother example, in FIG. 7, the T-bar 104 advantageously includes adovetail lateral guide 1930 that laterally slides within a dovetailchannel 1932 formed therein. As yet a further example, in FIG. 12, araised rib 1934 on a frame ground 1936 is received within a rectangularslot 1938 formed in a T-bar 1940. To further facilitate non-bindinglateral translation, distal and proximal lateral bearing tracks eachinclude a respective plurality of ball bearings 1946, 1948. As yet afurther example, in FIG. 13, a plurality of frame lateral grooves1950-1954 are formed in a frame ground 1956 with corresponding T-barlateral grooves 1958-1962 in a T-bar 1964. Slide rollers 1966-1970reside trapped within respective pairs of lateral grooves 1950/1958,1952/1960, 1954/1962. These are by no means an exhaustive list oflateral guidance members that prevent unwanted cocking or rotation ofthe T-bar 1940.

Double Pivot Frame Ground and Single Pivot Closure Combination.

In FIGS. 14-15, an alternate frame ground and closure mechanism 2200includes a surgical instrument 2202 that includes double pivoting frameassembly 2204. In particular, a frame ground 2206 is connected to distalframe member 2208 by a dual pivot frame dog bone 2210 having a proximalpivot pin 2212 pivotally engaging a proximal bore 2214 in frame ground2206 and a distal pivot pin 2216 engaging a distal bore 2218 of distalframe member 2208. A guidance slot 2220 is located on the underside ofdog bone 2210 for the guidance of a firing bar 66 (not shown in FIGS.14-15) therein. Knife slot 2222 is located in distal frame member 2208.As shown, articulation of the closure ring 2230 to a 45 degree anglearticulates distal frame member 2208 to a 45 degree angle andarticulates frame dog bone 2210 to half that angle. Consequently, firingbar 66 is subjected to the two shallow half bends that are spaced apartand obtains all the benefits listed above.

Outermost closure sleeve assembly 2224 is different in that only onepivot axis of the double pivoting design of the frame assembly 2204accommodates its longitudinal closure motion. As shown, a closure tubeshaft 2226 has a clevis 2228 at a distal end. Clevis 2228 is pivotallyengaged with a closure ring 2230. Closure ring 2230 has a proximal gear2232 formed at a distal end and pin 2234 pivotally engages an upper tang2236 of clevis 2228 and a lower arm 2238 engages with a lower tang 2240of clevis 2228. Holes 2242 in the clevis 2228 receive lateral guidespins 2243 and slidably attach a T-bar 2244 therein to engage proximalgear 2232 of the closure ring 2230. Thus, this alternate mechanism 2200uses a reversed single/dual pivot alternate concept from the previouslydescribed mechanism. That is, the alternate closure mechanism has asingle pivot and the alternate frame ground has a dual pivot, unlike thepreviously described dual pivot closure mechanism with a single pivotframe ground.

It should be appreciated in light of the present disclosure that a dualpivoting frame link between proximal and distal frame portions has anumber of advantages. While not an inclusive list, these advantagesinclude facilitating guidance of firing members through the articulationwith a wider radius of bending, Thereby allowing for reduced force tofire, reduced likelihood of binding and failure, and/or allowing for useof a stronger but more rigid firing member. Applications consistent withaspects of the invention may incorporate a closure tube assembly thatalso has multiple pivoting points, or a flexible cylindrical portion atthe articulation joint. In addition, a plurality of articulation jointsmay be serially attached one to the other so that no one articulationjoint is required to impart a large angular deflection. Alternatively,the articulating closure sleeve may be longitudinally fixed, serving asa cover, with the firing bar effecting closure, cutting and stapling.The double pivoting frame link serves to facilitate movement of thefiring bar.

It should further be appreciated that while guiding the firing bar asdepicted has certain advantages, a double pivoting connection may beformed by one or more frame links offset from the path of thearticulating firing bar. It should further be appreciated that the oneor more firing links may include at least a portion of resilientmaterial along its length to further facilitate articulation.

It should further yet be appreciated that incorporating articulationactuators to position the proximal frame ground portion, distal frameground portion, and the double pivoting frame link therebetween mayinstead actuate the closure sleeve, allowing the frame ground assemblyto be passively articulated in response to articulation of the closesleeve assembly.

Laterally Moving Articulation Mechanism

In FIG. 16, an implement portion 2412 for a surgical instrument 2402includes multiple pivot closure assembly 2204. Outermost closure sleeveassembly 2424 is attached to a closure tube shaft 2426 by a flexibleclosure joint 2425 that encompasses a single pivot frame articulationjoint (not shown in FIG. 16). Alternatively, a flex-neck type framearticulation joint may be encompassed. The multiple pivot closureassembly 2446 is laterally flexible by having left and right verticalslits 2427, 2429 formed into a resilient material (e.g., polymer,silicone). Top and bottom bands 2451 of material maintain longitudinallength of the flexible closure joint 2425 and transfer a firing motion.

While the present invention has been illustrated by description ofseveral embodiments and while the illustrative embodiments have beendescribed in considerable detail, it is not the intention of theapplicant to restrict or in any way limit the scope of the appendedclaims to such detail. Additional advantages and modifications mayreadily appear to those skilled in the art.

For example, while a hydraulically powered articulation approach isdisclosed herein, it should be appreciated that applications consistentwith aspects of the present invention may be mechanically orelectrically powered.

As another example, an end effector of a surgical instrument may includevarious types of actuating members that may be coupled to receive aselective reciprocating longitudinal motion carried by a sleeve assemblyover an articulating shaft.

1. A surgical instrument, comprising: an elongate shaft having aproximal end, a distal end, and a longitudinal axis extendingtherebetween, the elongate shaft further comprising a frame assembly andan articulating closure sleeve; an end effector comprising a lower jawand a pivotally attached upper jaw, wherein the pivotally attached upperjaw comprises an anvil presenting a staple forming surface; anarticulation joint of the frame assembly, the articulation joint of theframe assembly comprising: i) a distal frame ground portion fixedlyattached to the lower jaw of the end effector, ii) a proximal frameground portion, and iii) a frame link bridging a longitudinal gapbetween the distal frame ground portion and the proximal frame groundportion, the frame link being pivotally attached to the distal frameground portion to define a first pivot point, the frame link beingfurther pivotally attached to the proximal frame ground portion todefine a second pivot point, wherein the distal frame ground portion ispivotable relative to the proximal frame ground portion about the firstpivot point, wherein the distal frame ground portion is furtherpivotable relative to the proximal frame ground portion about the secondpivot point, wherein the first pivot point is longitudinally spaceddistal to the second pivot point; a handle portion attached to aproximal end of the proximal frame ground portion for pivotal attachmentof the end effector to the handle with the frame assembly, the handleportion being further operatively configured to longitudinally couple aclosure motion to the upper jaw with the articulating closure sleeve; afiring bar guided within the elongate shaft and longitudinallyreciprocated by the handle portion; and a staple cartridge receivedwithin the end effector responsive to the distal movement of the firingbar; wherein the articulating closure sleeve comprises an articulatingsleeve portion positioned to traverse over and encompass at least aportion of the frame link, and to distally engage with the upper jaw toeffect pivoting of the upper jaw, wherein the articulating closuresleeve comprises a proximal portion and a distal portion pivotallycoupled together by a closure sleeve articulation joint, wherein theclosure sleeve articulation joint defines a third pivot point, whereinthe proximal portion of the articulating closure sleeve is pivotablerelative to the distal portion of the articulation closure sleeve aboutthe third pivot point, wherein the closure sleeve articulation joint isoperable to translate relative to the articulation joint of the frameassembly.
 2. The surgical instrument of claim 1, wherein thearticulating closure sleeve assembly further comprises a distal closuretube portion engaged to the upper jaw and a proximal closure tubeportion coupled to the handle portion, the articulating portion of thearticulating closure sleeve comprises upper and lower opposing andpivotally pinned tangs presented by respective distal and proximalclosure tube portions.
 3. The surgical instrument of claim 1, whereinthe proximal portion of the articulating closure sleeve and the distalportion of the articulating closure sleeve present opposing clevises,the frame link including laterally projecting cylindrical pins.
 4. Thesurgical instrument of claim 3, wherein the frame link includes a knifeslot open laterally opposite to the laterally projecting cylindricalpins.
 5. The surgical instrument of claim 1, wherein the frame linkincludes a knife slot positioned to laterally guide the firing bar. 6.The surgical instrument of claim 1, wherein the frame link comprises adog bone link including a tapered mid portion.
 7. The surgicalinstrument of claim 1, wherein the frame link comprises a resilientmaterial.
 8. The surgical instrument of claim 1, wherein the frame linkcomprises a rigid material.
 9. The surgical instrument of claim 1,wherein the handle portion further comprises a closure triggeroperatively coupled to the articulating closure sleeve to effect closuremovement thereof.
 10. The surgical instrument of claim 1, whereinelongate shaft and end effector are cross sectionally sized to passthrough a cannula to a surgical site within a patient's body.
 11. Asurgical instrument, comprising: an elongate shaft having a proximalend, a distal end, and a longitudinal axis extending therebetween, theelongate shaft further comprising a frame assembly encompassed by alongitudinally movable, slidingly received articulating closure sleeve;an end effector comprising a staple applying assembly, the stapleapplying assembly comprising an elongate channel, a staple cartridgeengaged in the elongate channel, and a pivotable upper jaw having ananvil, wherein the anvil is pivotally attached to the elongate channel,the anvil presenting a staple forming surface to the staple cartridge;an articulation joint of the frame assembly, the articulation jointcomprising a distal frame ground portion fixedly attached to theelongate channel of the staple applying assembly, a proximal frameground portion, and a frame link pivotally attached to the distal frameground portion by a first pivot pin, such that the distal frame groundportion is pivotable relative to the frame link about the first pivotpin, wherein the frame link is further pivotally attached to theproximal frame ground portion by a second pivot pin, such that theproximal frame ground portion is pivotable relative to the frame linkabout the second pivot pin, wherein the first pivot pin and the secondpivot pin are spaced longitudinally apart; and a handle portion attachedto a proximal end of the proximal frame ground portion and operativelyconfigured to longitudinally couple a closure motion to the articulatingclosure sleeve, wherein the staple applying assembly is pivotallyattached to the handle portion by the frame link; wherein thearticulating closure sleeve comprises an articulating portion positionedto traverse over and encompass at least a portion of the frame link, andto distally engage with the upper jaw to effect pivoting of the upperjaw.
 12. The surgical instrument of claim 11, further comprising afiring bar guided within the elongate shaft and longitudinallyreciprocated by the handle portion, the staple cartridge received withinthe end effector responsive to the distal movement of the firing bar.13. The surgical instrument of claim 12, wherein the frame link includesa knife slot positioned to laterally guide the firing bar.
 14. Thesurgical instrument of claim 11, wherein the frame link comprises a dogbone link including a tapered mid portion.
 15. The surgical instrumentof claim 11, wherein the frame link comprises a resilient material. 16.The surgical instrument of claim 11, wherein the frame link comprises arigid material.
 17. The surgical instrument of claim 11, wherein thehandle portion further comprises a closure trigger operatively coupledto the articulating closure sleeve to effect closure movement thereof.18. The surgical instrument of claim 11, wherein the elongate shaft andend effector are cross sectionally sized to pass through a cannula to asurgical site within a patient's body.
 19. A surgical instrument,comprising: an elongate shaft having a distal end, a proximal end, and alongitudinal axis extending therebetween, the elongate shaft furthercomprising a frame assembly and an articulating sleeve; an end effectorcoupled with the elongate shaft, the end effector including an anvilmember, the end effector further comprising a lower jaw; an articulationjoint of the frame assembly, the articulation joint comprising a distalframe ground portion fixedly attached to the lower jaw of the endeffector, a proximal frame ground portion longitudinally separated fromthe distal frame ground portion, and a frame link pivotally attached tothe distal frame ground portion and pivotally attached to the proximalframe ground portion, wherein the frame link is pivotally coupled withthe proximal frame ground portion by a first pivot member, wherein theproximal frame ground portion is pivotable relative to the frame linkabout the first pivot member, wherein the frame link is pivotallycoupled with the distal frame ground portion by a second pivot member,wherein the distal frame ground portion is pivotable relative to theframe link about the second pivot member, wherein the first pivot memberand the second pivot member are discrete relative to each other, whereinthe first pivot member and the second pivot member are spacedlongitudinally apart from each other, wherein the frame link is rigid,wherein the frame link includes a knife slot; and a handle portionattached to a proximal end of the frame assembly for dual pivotalattachment of the end effector to the handle portion, the handle portionbeing further operatively configured to longitudinally couple alongitudinal motion to the articulating sleeve; wherein the articulatingsleeve comprises an articulating sleeve portion positioned to traverseover and encompass at least a portion of the frame link and to distallyengage the anvil member of the end effector.